Healthcare Provider Details

I. General information

NPI: 1477300663
Provider Name (Legal Business Name): CHANIECE DOYLE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45900 GEDDES RD
CANTON MI
48188-2306
US

IV. Provider business mailing address

12947 WOODBINE
REDFORD MI
48239-2615
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704308511
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704308511
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: